Skin rhagade refers to the appearance of fissures of varying sizes and depths on the skin surface, simply referred to as "rhagade."

Zhubing Yuanhou Lun calls it "rhagade," "meat fissure," or "chè liè"; Suwen Bingji Qiyi Baomingji refers to it as "cūn jiē"; Waike Qixuan calls it "cūn liè"; and the "Chinese Medicine Clinical Essentials" refers to it as "dry fissure" or "dry crack." Today, it is also referred to as "crack," "fissure," "cracking," "crevice," or "split," all of which fall within the scope of this condition.

Skin fissures caused by external injuries are not within the scope of this condition.

bubble_chart Pattern Analysis

1. Blood Deficiencywind-dryness︰Skin lesions often occur on the palms, backs of hands, fingertips, heels, etc., presenting as linear or groove-like fissures. Mild cases may cause dry skin discomfort, while severe cases may be accompanied by surface bleeding and pain. The fissures vary in length and depth, often appearing on thickened, hardened skin. The condition progresses slowly, worsens in cold seasons, and may alleviate or heal spontaneously as the weather warms. The tongue texture is pale, and the pulse manifestation is thin and weak. It is commonly seen in individuals engaged in occupations such as boating, cart pushing, fishing, carpentry, and bricklaying, due to frequent friction, injury, soaking, or exposure to wind-cold. Therefore, the characteristic of the skin lesions is that rhagades often occur on the palms, soles, sides of feet, backs of hands, finger joints, fingertips, etc., either singly or multiply, mostly appearing as linear or groove-like fissures. The fissures typically develop on thickened skin prone to friction. Treatment should focus on nourishing blood, extinguishing wind, and moistening dryness, using Angelica Decoction, with external application of moisturizing ointment.
2. Blood-heat Wind-dryness︰Rhagade commonly occurs on the extensor sides of elbows and knees, the lower back, and buttocks. Initially presenting as erythema, it gradually expands and merges into large patches, often covered with silvery-white scales and accompanied by itching. Over time, the condition may lead to skin fissures that are large and deep, causing pain and even bleeding. The tongue appears deep red with little coating, and the pulse is thin and rapid. It is often caused by a constitutional predisposition to blood heat, exposure to harsh wind, or excessive consumption of spicy, fried, or wind-inducing foods, leading to pathogenic heat accumulating in the blood aspect. This results in dry, cracked skin and, in severe cases, bleeding and pain. The condition frequently affects areas such as the elbows, knees, waist, and back, where pathogens are expelled from the exterior. The lesions have a bright or dark red base covered with silvery-white scales, which may bleed when scratched. Treatment should focus on cooling the blood and moistening dryness, using the Ke Yin No. 2 formula, with external application of Hydrargyrum Oxydatum Crudum ointment.
3. Spleen Deficiency with Dampness Retention︰Rhagades often occur symmetrically on the palms, metatarsus, back of the hands, behind the ears, under the breasts, scrotum, groin, and other areas. Initially, they present as erythema, papules, blisters, and itching. Over time, the skin lesions become dark, thickened, dry, and scaly, with rhagades causing both pain and itching. The tongue texture appears dark red, the tongue coating is peeled, and the pulse manifestation is wiry and thin. This condition is often caused by improper diet, leading to internal spleen dampness accumulation, compounded by external dampness exposure such as soaking in water or humid conditions after rain. This results in the combination of internal and external dampness pathogens, stagnating in the skin and causing malnutrition, leading to rhagades. The characteristic skin lesions include initial exudation, erosion, and blisters, which can occur symmetrically in any area. Treatment should focus on fortifying the spleen, eliminating dampness, and relieving itching. Recommended formulas include the Spleen-Fortifying Dampness-Eliminating Decoction, external application of Dampness-Toxin Ointment, and Dampness-Dispersing Powder.
4. Dampness Toxin Erosion︰It initially often occurs unilaterally, later appearing bilaterally on the dorsum of the hands, palms, soles, toe webs, heels, and lateral aspects of the feet. Early symptoms include itching and scaling, gradually merging into patches with thickened skin and fissures, sometimes accompanied by onychomycosis, a red tongue with white greasy coating, and a slippery, rapid pulse. It is mostly caused by immersion in water or dampness from sweating, leading to the accumulation of damp-toxin pathogens in the skin. Lesions commonly occur in the toe webs, lateral aspects of the feet, heels, dorsum of the hands, and palms, either singly or multiply, and may be asymmetrical. Initially, scattered itchy blisters appear, which dry and scale, merging into coin-shaped or polycyclic patches. Prolonged scratching leads to hyperkeratosis and thickening. In areas of rhagades, there is fine scaling with deep fissures that are painful to touch and worsen in winter. Treatment should focus on clearing heat, dispelling dampness, removing toxins, and relieving itching. The recommended formula is Dampness-Eliminating Decoction, with external treatment using a vinegar soak formula.

bubble_chart Documentation

1. Zhubing Yuanhou Lun．skin rhagades: "Rhagade refers to the breaking of muscles. It is said that in winter, when one is exposed to wind-cold, the hands and feet break, hence it is called rhagade."
2. Zhubing Yuanhou Lun．flesh fissure: "Flesh fissure refers to the cracking and breaking of the skin due to tension. It is caused by the deficiency of striae and interstice, allowing wind evil to invade, which clashes with the blood, leading to the cracking and splitting of the flesh at the impacted areas."
3. Waike Qixuan．cracked sore: "Hardworking and poor individuals, disregarding wind and rain, develop cracked sores on their hands and feet in winter, with bleeding cracks, swelling, and unbearable pain. Externally, use radish juice to boil and wash the cracks, then apply melted suet oil, dripping it into the cracks for healing."